Evidence map›Paper›PMID 36514163›Full record

ArticleTrials2022

Assessing the efficacy and safety of mycophenolate mofetil versus azathioprine in patients with autoimmune hepatitis (CAMARO trial): study protocol for a randomised controlled trial.

Romée J A L M Snijders, Anna E C Stoelinga, Tom J G Gevers, Simon Pape, Maaike Biewenga, Robert C Verdonk, Hendrik J M de Jonge, Jan Maarten Vrolijk, Sjoerd F Bakker, Thomas Vanwolleghem and 18 more

Open access · goldAbstract readClinical Trial Protocol
In one paragraph

Article in Trials, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
1.5field-weighted citation impact, top 17% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed, 11 citations in OpenAlex.

  1. AIH Therapy: Beyond First‑Line.Current hepatology reports · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

28 authors at 20 institutions in 3 countries.

Romée J A L M Snijders *Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands. romee.snijders@radboudumc.nl.ORCID http://orcid.org/0000-0003-3957-6261
Anna E C Stoelinga *Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
Tom J G GeversDepartment of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Simon PapeDepartment of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Maaike BiewengaDepartment of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
Robert C VerdonkDepartment of Gastroenterology and Hepatology, St. Antonius Hospital, Nieuwegein, The Netherlands.
Hendrik J M de JongeDepartment of Gastroenterology and Hepatology, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands.
Jan Maarten VrolijkDepartment of Gastroenterology and Hepatology, Rijnstate Hospital, Arnhem, The Netherlands.
Sjoerd F BakkerDepartment of Gastroenterology and Hepatology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
Thomas VanwolleghemDepartment of Gastroenterology and Hepatology, Antwerp University Hospital, Edegem, Belgium.
Ynto S de BoerEuropean Reference Network RARE-LIVER, Hamburg, Germany.
Martine A M C Baven PronkDepartment of Gastroenterology and Hepatology, Groene Hart Hospital, Gouda, The Netherlands.
Ulrich H W BeuersEuropean Reference Network RARE-LIVER, Hamburg, Germany.
Adriaan J van der MeerDepartment of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Nicole M F van GervenDepartment of Gastroenterology and Hepatology, Rode Kruis Hospital, Beverwijk, The Netherlands.
Marijn G M SijtsmaDepartment of Gastroenterology and Hepatology, St. Jansdal Hospital, Harderwijk, The Netherlands.
Bart J VerwerDepartment of Gastroenterology and Hepatology, Spaarne Gasthuis, Haarlem, The Netherlands.
Ingrid A M GisbertzDepartment of Gastroenterology and Hepatology, Hospital Bernhoven, Uden, The Netherlands.
Maartje BartelinkDepartment of Gastroenterology and Hepatology, Deventer Hospital, Deventer, The Netherlands.
Floris F van den BrandDepartment of Gastroenterology and Hepatology, OLVG Oost, Amsterdam, The Netherlands.
Kerem Sebib KorkmazDepartment of Gastroenterology and Hepatology, IJselland Hospital, Capelle aan den Ijssel, The Netherlands.
Aad P van den BergDepartment of Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands.
Maureen M J GuichelaarDepartment of Gastroenterology and Hepatology, Medisch Spectrum Twente, Enschede, The Netherlands.
Khalida SoufidiDepartment of Gastroenterology and Hepatology, Zuyderland, Heerlen, The Netherlands.
Amar D LevensDepartment of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands.
Bart van Hoek *Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
Joost P H Drenth *Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands.
Dutch Autoimmune Hepatitis Working Group
Leiden University Medical Center · NLRadboud University Nijmegen · NLRijnstate Hospital · NLAmsterdam UMC Location University of Amsterdam · NLAmsterdam University Medical Centers · NLAntwerp University Hospital · BEDeventer Ziekenhuis · NLElisabeth-TweeSteden Ziekenhuis · NLErasmus MC · NLGGZ Oost Brabant · NLGroene Hart Ziekenhuis · NLIJsselland Ziekenhuis · NLJeroen Bosch Ziekenhuis · NLMedisch Spectrum Twente · NLRode Kruis Ziekenhuis · NLSpaarne Gasthuis · NLSt. Antonius Ziekenhuis · NLUniversity Medical Center Groningen · NLZiekenhuis Bernhoven · NLZuyderland Medisch Centrum · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundCurrently, the standard therapy for autoimmune hepatitis (AIH) consists of a combination of prednisolone and azathioprine. However, 15% of patients are intolerant to azathioprine which necessitates cessation of azathioprine or changes in therapy. In addition, not all patients achieve complete biochemical response (CR). Uncontrolled data indicate that mycophenolate mofetil (MMF) can induce CR in a majority of patients. Better understanding of first-line treatment and robust evidence from randomised clinical trials are needed. The aim of this study was to explore the potential benefits of MMF as compared to azathioprine, both combined with prednisolone, as induction therapy in a randomised controlled trial in patients with treatment-naive AIH.

methodsCAMARO is a randomised (1:1), open-label, parallel-group, multicentre superiority trial. All patients with AIH are screened for eligibility. Seventy adult patients with AIH from fourteen centres in the Netherlands and Belgium will be randomised to receive MMF or azathioprine. Both treatment arms will start with prednisolone as induction therapy. The primary outcome is biochemical remission, defined as serum levels of alanine aminotransferase and immunoglobulin G below the upper limit of normal. Secondary outcomes include safety and tolerability of MMF and azathioprine, time to remission, changes in Model For End-Stage Liver Disease (MELD)-score, adverse events, and aspects of quality of life. The study period will last for 24 weeks. DISCUSSION: The CAMARO trial investigates whether treatment with MMF and prednisolone increases the proportion of patients in remission compared with azathioprine and prednisolone as the current standard treatment strategy. In addition, we reflect on the challenges of conducting a randomized trial in rare diseases.

trial registrationEudraCT 2016-001038-91 . Prospectively registered on 18 April 2016.

Indexed as

End Stage Liver DiseaseHepatitis, AutoimmuneAdultAzathioprineEquivalence Trials as TopicHumansImmunosuppressive AgentsMulticenter Studies as TopicMycophenolic AcidPrednisoloneQuality of LifeRandomized Controlled Trials as TopicSeverity of Illness IndexTreatment OutcomeAzathioprineImmunosuppressive AgentsMycophenolic AcidPrednisoloneAutoimmune hepatitisAzathioprineBiochemical remissionFirst-line treatmentInduction therapyMycophenolate mofetilPhase IV trialRandomized controlled trialRemission

Identifiers

PMID36514163
PMCPMC9745715
OpenAlexW4311349707

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.